Radiofrequency catheter ablation of common atrial flutter in 80 patients

Centre Hospitalier et Universitaire de Bordeaux, Hopital Cardiologique du Haut-Leveque, France.

OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency catheter ablation of common atrial flutter and to determine the optimal target sites in a large series of patients. BACKGROUND. Recent studies report the efficacy of radiofrequency current application in the low right atrial region to interrupt and prevent recurrences of common atrial flutter. However, larger groups of patients are required to confirm the efficacy of this technique and to specify the target sites. METHODS. Two different approaches were used to target the ablation site in 80 consecutive patients. In the first 50 patients, target sites were localized using both anatomic landmarks and electrophysiologic variables. Three anatomic landmarks were used: area 1 = between the tricuspid valve and inferior vena cava orifice; area 2 = between the tricuspid valve and coronary sinus ostium; area 3 = between the inferior vena cava and coronary sinus. The electrophysiologic criterion was to ablate when there was a stable atrial electrogram during the plateau phase. In the next 30 patients we assessed the effect of application of radiofrequency energy in a single line in area 1, 2 or 3 in groups of 10 patients. RESULTS. Overall atrial flutter was interrupted and rendered noninducible after a single session in 72 patients (90%) and could not be interrupted in 8 (10%). The mean (+/- SD) number of radiofrequency applications was 12 +/- 8. After a mean (+/- SD) follow-up of 20 +/- 8 months, recurrences occurred in 14 patients (17%). The location of the final successful site in the first group of 50 patients was in area 1 in 39%, area 2 in 36% and area 3 in 25%. In the next 30 patients, when lines of radiofrequency lesions were placed at several sites, they produced success rates of 70%, 40% and 10% at areas 1, 2 and 3, respectively. CONCLUSIONS. Radiofrequency catheter ablation of atrial flutter can be performed with a high success rate and is safe. The highest success rate is achieved with radiofrequency energy applied in the isthmus between the inferior vena cava orifice and tricuspid valve.

This article has been cited by other articles:

				G. Feld, M. Wharton, V. Plumb, E. Daoud, T. Friehling, L. Epstein, and EPT-1000 XP Cardiac Ablation System Investigators Radiofrequency catheter ablation of type 1 atrial flutter using large-tip 8- or 10-mm electrode catheters and a high-output radiofrequency energy generator: Results of a multicenter safety and efficacy study J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1466 - 1472. [Abstract] [Full Text] [PDF]

				E Bertaglia, F Zoppo, A Bonso, A Proclemer, R Verlato, L Coro, R Mantovan, D D'Este, F Zerbo, and P Pascotto Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence Heart, January 1, 2004; 90(1): 59 - 63. [Abstract] [Full Text] [PDF]

				J. Chen, C. de Chillou, O-J. Ohm, P. I. Hoff, O. Rossvoll, M. Andronache, N. Sadoul, I. Magnin-Poull, K. S. Erga, and E. Aliot Acute resumption of conduction in the cavotricuspid isthmus after catheter ablation in patients with common atrial flutter: Real-time evaluation and long-term follow-up Europace, January 1, 2002; 4(3): 255 - 263. [Abstract] [PDF]

				H. Tada, H. Oral, C. Sticherling, S. P. Chough, R. L. Baker, K. Wasmer, F. Pelosi Jr, B. P. Knight, S. A. Strickberger, and F. Morady Double potentials along the ablation line as a guide to radiofrequency ablation of typical atrial flutter J. Am. Coll. Cardiol., September 1, 2001; 38(3): 750 - 755. [Abstract] [Full Text] [PDF]

				N. Fragakis, A. Kotsakis, N. Patel, J. Bostock, E. Rosenthal, P. Holt, C. Bucknall, and J. Gill Atrial flutter ablation: Efficacy and cost-effectiveness of a single decapolar electrode to demonstrate bidirectional isthmus block Europace, January 1, 2001; 3(4): 304 - 310. [Abstract] [PDF]

				A. Natale, K. H. Newby, E. Pisano, F. Leonelli, R. Fanelli, D. Potenza, S. Beheiry, and G. Tomassoni Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1898 - 1904. [Abstract] [Full Text] [PDF]

				C Reithmann, E Hoffmann, G Spitzlberger, U Dorwarth, A Gerth, T Remp, and G Steinbeck Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation Eur. Heart J., April 1, 2000; 21(7): 565 - 572. [Abstract] [PDF]

				Y. Iesaka, T. Yamane, M. Goya, A. Takahashi, H. Fujiwara, Y. Okamoto, Y. Soejima, J. Nitta, A. Nogami, K. Aonuma, et al. A jump in cycle length of orthodromic common atrial flutter during catheter ablation at the isthmus between the inferior vena cava and tricuspid annulus: Evidence of dual isthmus conduction directed to dual septal exits Europace, January 1, 2000; 2(2): 163 - 171. [Abstract] [PDF]

				J. Chen, Christian de Chillou, T. Basiouny, N. Sadoul, J. D. S. Filho, I. Magnin-Poull, M. Messier, and E. Aliot Cavotricuspid Isthmus Mapping to Assess Bidirectional Block During Common Atrial Flutter Radiofrequency Ablation Circulation, December 21, 1999; 100(25): 2507 - 2513. [Abstract] [Full Text] [PDF]

				A. Takahashi, D. C. Shah, P. Jais, M. Hocini, J. Clementy, and M. Haissaguerre Partial cavotricuspid isthmus block before ablation in patients with typical atrial flutter J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1996 - 2002. [Abstract] [Full Text] [PDF]

				A. Nabar, L.-M. Rodriguez, C. Timmermans, A. van den Dool, J. L. R. M. Smeets, and H. J. J. Wellens Effect of Right Atrial Isthmus Ablation on the Occurrence of Atrial Fibrillation : Observations in Four Patient Groups Having Type I Atrial Flutter With or Without Associated Atrial Fibrillation Circulation, March 23, 1999; 99(11): 1441 - 1445. [Abstract] [Full Text] [PDF]

				D. Shah, M. Haissaguerre, P. Jais, A. Takahashi, M. Hocini, and J. Clementy High-Density Mapping of Activation Through an Incomplete Isthmus Ablation Line Circulation, January 19, 1999; 99(2): 211 - 215. [Abstract] [Full Text] [PDF]

				H. Yamabe, K. Okumura, I. Misumi, H. Fukushima, K. Ueno, Y. Kimura, and Y. Hokamura Role of bipolar electrogram polarity mapping in localizing recurrent conduction in the isthmus early and late after ablation of atrial flutter J. Am. Coll. Cardiol., January 1, 1999; 33(1): 39 - 45. [Abstract] [Full Text] [PDF]

				S. Riva, C. Tondo, C. Carbucicchio, P. Galimberti, G. Fassini, and P. Della Bella Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment Europace, January 1, 1999; 1(4): 242 - 247. [Abstract] [PDF]

				H. Paydak, J. G. Kall, M. C. Burke, D. Rubenstein, D. E. Kopp, R. J. Verdino, and D. J. Wilber Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter : Time to Onset, Determinants, and Clinical Course Circulation, July 28, 1998; 98(4): 315 - 322. [Abstract] [Full Text] [PDF]

				D. C. Shah, P. Jais, M. Haissaguerre, S. Chouairi, A. Takahashi, M. Hocini, S. Garrigue, and J. Clementy Three-dimensional Mapping of the Common Atrial Flutter Circuit in the Right Atrium Circulation, December 2, 1997; 96(11): 3904 - 3912. [Abstract] [Full Text]

				D. C. Shah, M. Haissaguerre, P. Jais, B. Fischer, A. Takahashi, M. Hocini, and J. Clementy Simplified Electrophysiologically Directed Catheter Ablation of Recurrent Common Atrial Flutter Circulation, October 21, 1997; 96(8): 2505 - 2508. [Abstract] [Full Text]

				C.-T. Tai, S.-A. Chen, C.-E. Chiang, S.-H. Lee, K.-C. Ueng, Z.-C. Wen, J.-L. Huang, Y.-J. Chen, W.-C. Yu, A.-N. Feng, et al. Characterization of Low Right Atrial Isthmus as the Slow Conduction Zone and Pharmacological Target in Typical Atrial Flutter Circulation, October 21, 1997; 96(8): 2601 - 2611. [Abstract] [Full Text]

				S. Shpun, L. Gepstein, G. Hayam, and S. A. Ben-Haim Guidance of Radiofrequency Endocardial Ablation With Real-time Three-dimensional Magnetic Navigation System Circulation, September 16, 1997; 96(6): 2016 - 2021. [Abstract] [Full Text]

				H. Poty, N. Saoudi, M. Nair, F. Anselme, and B. Letac Radiofrequency Catheter Ablation of Atrial Flutter: Further Insights Into the Various Types of Isthmus Block: Application to Ablation During Sinus Rhythm Circulation, December 15, 1996; 94(12): 3204 - 3213. [Abstract] [Full Text]

				B. Cauchemez, M. Haissaguerre, B. Fischer, O. Thomas, J. Clementy, and P. Coumel Electrophysiological Effects of Catheter Ablation of Inferior Vena Cava–Tricuspid Annulus Isthmus in Common Atrial Flutter Circulation, January 15, 1996; 93(2): 284 - 294. [Abstract] [Full Text]